ACEs Research in Tulsa

Transcription

1 ACEs Research in Tulsa Jennifer Hays-Grudo, PhD Regents Professor Human Development and Family Science Adjunct Professor of Pediatrics OSU Center for Health Sciences Project Director Center for Integrated Research on Childhood Adversity (CIRCA)

2 ACEs are prevalent NOW in Oklahoma ADVERSE CHILDHOOD EXPERIENCES: NATIONAL AND STATELEVEL PREVALENCE. Vanessa Sacks, M.P.P., David Murphey, Ph.D., and Kristin Moore, Ph.D., Child Trends States vary in the pattern of specific ACEs. Connecticut and New Jersey have some of the lowest prevalence rates nationally for all ACEs, while Oklahoma has consistently high prevalence.

3 Oklahoma ACEs Survey National survey by state about child s ACEs 30% - Economic Hardship (ranked 45th) 30% - Divorce (ranked 50th) 17% - Parent abused alcohol or drugs (49th) 11% -Witnessed domestic violence (50th) 12% - Had a parent with a mental illness (43rd) 10% - Had a parent incarcerated (48th) 13% -Was a victim of or witnessed neighborhood violence (49th) 17% - Already experienced 3 or more ACEs (49th) Highest rates (with Montana and W. Virginia) of children with >4

4 Oklahoma history of trauma & stress

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7 Allostasis and Allostatic Load Figure 1. The Stress Response and Development of Allostatic Load. The perception of stress is influenced by one's experiences, genetics, and behavior. When the brain perceives an experience as stressful, physiologic and behavioral responses are initiated, leading to allostasis and adaptation. Over time, allostatic load can accumulate, and the overexposure to mediators of neural, endocrine, and immune stress can have adverse effects on various organ systems, leading to disease. McEwen, Bruce. Protective and Damaging Effects of Stress Mediators. New England Journal of Medicine. 338(3): , January 15, 1998.

8 Stress response McEwen. N Eng J Med 1998

9 Allostatic load: Wears out body s ability to regulate stress

10 Tulsa Children Project Do parents ACEs affect children? Parent measures ACE scores, stress Health status Access to care Child measures Behavioral dysregulation (DECA scores) Biological dysregulation (salivary cortisol) Partners: OU ECEI, SSW, Educare Funded by GKFF

11 ACEs and behavioral dysregulation Parent s ACEs predict current stress, which increases parenting distress, and decreases perceived the parentchild relationship, resulting in lower teacher ratings of child s socioemotional development (DECA) Castle, Guss, Hays-Grudo, Miller-Cribbs & Horm, Head Start Research Conference, 2016

12 ACEs and stress hormone dysregulation.22** Parent Depression.22*** Parent ACEs.24*** Parent-child Conflict -.16* % Decrease in Child Cortisol.27*** Parent Stress.14* Note: ***p <.001, **p <.01, *p <.05; model fit: χ 2 (4)= 3.87, p =.42, RMSEA =.00, CFI = 1.00, TLI = Hays-Grudo, Bosler, Teague, Castle, Guss, Miller-Cribbs, Morris & Horm, World Congress on Infant Mental Health, Prague, June 2016.

13 Parent ACEs, depression, relationship and child cortisol Cortisol AM PM Low ACEs High ACEs Cortisol AM PM Low Parent Depression High Parent Depression

14 Since ACEs affect neurodevelopment ACEs-based interventions Traditional interventions Early death Chronic disease and conditions Problematic behaviors Impaired social, cognitive, emotional functioning Impaired bio/neurological functioning Adverse Childhood Experiences

15 ACEs-informed interventions Early death Chronic disease and conditions Problematic behaviors Games to improve executive function skills MBSR (mindfulness) to create new synapses Impaired social, cognitive, emotional functioning Impaired bio/neurological functioning Adverse Childhood Experiences

16 Super Parents Evaluation 1,2,3,4 Parenting + Tulsa Children s Project Mindfulness training and practice Family games promoting executive function skills Comparisons of pre- and post-test measures showed significant increases in positive parenting attitudes parenting efficacy parent executive function significant decreases in child emotional problems and hyperactivity. Three-month comparisons showed significant increases in parenting efficacy parent self-compassion parent mindfulness significant decreases in parent perceived stress child emotional problems Now in the revision of Active Parenting program (AP: First Five Years) Slocum, Bosler, Hays-Grudo & Morris, 2016

17 Three avenues to treat trauma Top down by talking, (re-connecting with others, allowing past and current experiences to be acknowledged and processed Medications that shut down inappropriate alarm reactions, or other technologies that change the way the brain organizes information Bottom up by allowing the body to have experiences that viscerally contradict the helplessness, rage, or collapse that result from trauma.

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19 Protective and Compensatory Experiences (PACEs) Morris, Hays-Grudo et al (2015) Direct Experience Have someone who loved you unconditionally (you did not doubt that they cared about you)? Environmental conditions Have an engaging hobby -- an artistic or intellectual pastime either alone or in a group? Have at least one best friend (someone you could trust, had fun with)? Do anything regularly to help others or do special projects in the community to help others? Were you regularly involved in organized sports groups or other physical activity? Were you an active member of at least one civic group or a non-sport social group? Have an adult (not your parent) you trusted and could count on when you needed help or advice? Live in a home that was typically clean AND safe with enough food to eat? Have a school that provided the resources and experiences you needed to learn? Were there rules in your home that were clear and fairly administered?

20 Identify and address sources of disparities in health and development Build research capacity Tulsa and Oklahoma Total funding is $11.3M for five years Partnerships between OSU Center for Health Sciences, OSU-Stillwater, OSU-Tulsa, OU-Tulsa Projects, pilot projects (annual), Core support units